PRIVATE SECURITY CERTIFICATIONS/LICENSES

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "PRIVATE SECURITY CERTIFICATIONS/LICENSES"

Transcription

1 PS-1 Application Department of Public Safety Standards and Training, Private Security/ Investigator Program 550 Monmouth Ave N, Monmouth OR Ph #. (503) FAX (503) PRIVATE SECURITY CERTIFICATIONS/LICENSES 1. UNARMED PRIVATE SECURITY OFFICER - Must be at least 18 years of age 2. ARMED/UNARMED PRIVATE SECURITY OFFICER - Must be at least 21 years of age 3. ALARM MONITOR This certification is for officers whose primary responsibility is monitoring alarms. 4. SUPERVISORY MANAGER Has a primary responsibility of supervising certified officers, 5. CERTIFIED PRIVATE SECURITY INSTRUCTORS - ** Criminal History Fingerprint Fee - $50.00, Certification (2 yr.) fee - $80.00 = $ * SPECIFIC TRAINING IS REQUIRED FOR INSTRUCTOR 6. EXECUTIVE MANAGER Criminal History Fingerprint Fee - $50.00, Certification (2 yr.) fee- $ = $ **Additional Requirements for Private Security Instructors Private Security Instructors All private security instructors please submit a resume with your application materials. Your resume must clearly show your education, work experience, and qualifications. If applying for a private security firearms instructor certification you must hold and provide proof of current certification from the NRA (Law Enforcement Instructor Development School), FBI (firearms instructor), FLETC (firearms instructor), Washington State Criminal Justice Fire Arms Instructor Course or DPSST (certified firearms instructor course). INVESTIGATORS LICENSES 7. PRIVATE INVESTIGATOR** Application fee $79*, License Fee $ PROVISIONAL INVESTIGATOR Application fee $79*, License Fee $ TEMPORARY INVESTIGATOR License fee $ INACTIVE INVESTIGATOR Application fee $50 * Original application fee covers the criminal background check and exam. Applicants for licensure as a private investigator must submit two passport sized photo s for their photo identification card. The pictures submitted should be no larger then 2 x 3. (Passport photos can be obtained at local retailers.) **Additional Requirements for Private Investigators Private Investigators If applying for an investigators license you must clearly show you have 1500 hours of education and/or experience It is necessary to submit a resume with your application materials. Your resume must clearly show your education, work experience, and qualifications. Original bond or letter of credit must be provided and must list the application as principal or certificate of insurance must be submitted. In addition to the certificate, if the investigator is covered under the employer s insurance policy, your employer must submit a letter verifying that you are covered.

2 Information and Special Instructions Tips For Completing Your Application The Application must be completely filled out, remember to read each section carefully. Do not leave blank spaces. If a question or statement does not pertain to you, fill in the blank space provided with an N/A for not applicable. If you have questions about the certification process please visit our website for general information or call us at Did you include your fee, resume, bond info? All required materials and fees must be included for your application to be processed. Requirements very between disciplines and depend on the license or certificate sought. Contact DPSST if you have any questions. Personal Information: You must provide us with a current home and business address. If we are unable to contact you by mail, your application for certification may be terminated. When filling in your residence and employment history, be sure to cover the full 10 year period back from today s date, even if you were living with your parents or unemployed. Personal References: Your three personal references must include phone and addresses. Criminal History Declarations: You must accurately and completely disclose your entire conviction history in section 6. This includes all felonies, and/or misdemeanor crimes you have been convicted of. If you fail to disclose a conviction, your application may be disqualified and you may be subject to Civil Penalty. Be aware that some traffic offenses may be classified as misdemeanors/felonies, for example, Reckless Driving, Driving Under the Influence of Intoxicants, and Driving While Suspended. If you are not sure, you should list the offense. Be certain to list date and location for each conviction. If you have history that you believe should have been expunged or removed from your record, but you do not know (proof in hand) that it was expunged or removed, you should verify your belief prior to applying. A crime is not removed from your record until you go through the formal process to have it removed. Believing a conviction was removed, or forgetting a conviction existed, is not a valid defense and your application for certification or licensure could be denied, based on failure to disclose the crime. If you have any questions or are unsure about your criminal past, you should research the issues for yourself prior to applying. Signing your application: You must sign or initial all applicable areas of the application. The final signature line must be signed and dated in front of a notary. Application Process Information Deficiency letters Notify you of a deficiency in the application or other required material. If you receive a deficiency letter, respond immediately. If you do not correct the deficiency in the timeline allowed, your application will be administratively terminated pursuant to Oregon law, and you must then reapply to receive your certification/license. Termination letters If you receive a letter notifying you that your application has been terminated, you cannot continue to provide services, to do so would be unlawful. Fingerprint processing To process your criminal background check you must submit two fingerprint cards: printed, filled out, signed and sealed in an evidence bag. DPSST does not control rejected prints. The best way to avoid rejections is to have your prints rolled by a skilled technician. Many applicants have their local law enforcement agency roll or scan their prints. Temporary work permit If you are currently employed as a security provider, or investigator, and your application is in process, but you are not yet certified, your licensed employer can issue you a temporary certification/license. This certification/license will allow you to perform services for up to 120 days while your application processes. Licenses from Out-of-State, who are seeking temporary licensure in Oregon, must provide a separate application available through DPSST. There is no temporary work provision for applicants for armed certification. SECTION 1 - INSTRUCTIONS

3 1. Complete the application fully. Do not leave any sections blank. If the question or statement does not apply to you please put an N/A in the space for not applicable. Incomplete applications could cause delays in processing. Sign your application in front of a Notary Public. 2. Pay required fees with cashier s check, business check or money order made payable to DPSST. Personal checks and cash are not accepted. All fees are non-refundable and must accompany the application. 3. Mail application and any other required materials along with the fees to the address listed above. 4. If adding a classification, complete Sec. 2, 1-14 only, Sec. 7; have notarized. If upgrading from unarmed to armed officer also attach a PS-23. SECTION 2 PERSONAL INFORMATION 1. Name 2.Alias Name(s) Last First Middle 3. Mailing Address City State Zip 4. E Mail Address 5. Date of Birth 6. Home phone 7. Work phone 8. SSN 9. Gender M F 10. Height 11. Weight U.S. citizen Yes No 12. Race (Circle one) A (Asian) B (African-American) H (Hispanic) I (Native American) W (Caucasian) 13. Natural eye color (Circle one) BRO BLK GRY BLU HAZ GRN Other 14. Natural hair color (Circle one) BRO BLK GRY BLN RED WHI Other 15. Driver s License Number and State / 16. Expires 17. City/State of birth 18.Country of birth (if not U.S.) 19. Have you had a driver s license in another state? No Yes (State) (Year/s) SECTION 3 - CHARACTER REFERENCES - Fully list three names, addresses, phone numbers of three people you have known for at least 5 years Your references cannot be related by blood or marriage. 1. Name Telephone Street Address City State Zip 2. Name Telephone Street Address City State Zip 3. Name Telephone Street Address City State Zip You are required to provide your Social Security Number (SSN) to DPSST. The authority for this requirement is ORS and ORS , 42 USC 405(c)(2)(C)(i), 42 USC 666(a)(13) and OAR (10). Failure to provide your SSN will be basis to refuse issuance of a license or certificate. The record of your SSN will be used to obtain criminal background information, and for child support enforcement and tax administration (including identification) purposes only. Your SSN will remain on file with DPSST.

4 SECTION 4 - RESIDENCE SECTION Provide your last 10 years of residence history beginning with today s date and going back 10 full years. Include time in your parents' home or in transition if applicable. If necessary, use additional paper to complete Sections 7 and 8. This must be a complete 10-year history, without gaps in time. Date From Date To Complete Street Address City State Current SECTION 5 EMPLOYMENT SECTION Provide the last 10 consecutive years of employment or business history. If unemployed, student or homemaker, indicate time period and status. This must be a complete history, without gaps of time, for the past 10 years. Investigators must provide a current business name and address. Date From Date To Employer/Business Name Employer /Business Address Current

5 SECTION 6 AFFIRMATION OF CRIMINAL HISTORY Prior to filling out this section, read the special instructions section of this application. PLEASE CALL IF YOU HAVE ANY QUESTIONS REGARDING WHETHER OR NOT YOUR CRIMINAL HISTORY OR CONVICTION(S) WOULD DISQUALIFY YOU FROM CERTIFICATION/LICENSURE. Your application fee cannot be refunded if you are denied. Equivalent convictions from places other than Oregon will carry the same period of disqualification. You must disclose your entire criminal history below. Attach additional pages if necessary. Carefully read statements 1 through 6 below. Choose which statements apply to you by signing your name in the blank space provided. If a statement does not apply to you, fill in the blank space with an N/A for not applicable. If statements 2, 4 or 6 apply to you, also provide the additional information requested, add additional sheets if necessary. 1) I, (name), swear and/or affirm that I have never in my lifetime been convicted of any crime in this state or any other jurisdiction. 2) I, (name), swear and/or affirm that throughout my lifetime I have been convicted of the below listed crime(s) and no others. (If available attach copies of police reports and court documents. A crime is any offense at or above a misdemeanor (see instructions)). Charge Court Date State/Country Charge Court Date State/Country Charge Court Date State/Country 3) I, (name), swear and/or affirm I am not required to register as a sex offender in this state or any other. 4) I, (name), am required to register as a sex offender in the State of, for the crime of. FAILURE TO REPORT ALL CRIMINAL CONVICTIONS IS ITSELF A CRIME. IF YOUR CRIMINAL BACKGROUND CHECK SHOWS CONVICTIONS THAT WERE NOT DISCLOSED, YOUR APPLICATION MAY BE TERMINATED BY DPSST, AND YOU MAY BE SUBJECT TO CIVIL PENALTY. If applying for armed security officer or armed instructor, choose from and complete the following statements: 5) I, (name), swear and/or affirm I have never been committed to the Mental Health and Developmental Disability Services Division, or the equivalent, in this or any other state. 6) I, (name), have had my right to purchase or possess a firearm revoked/prohibited. Date State.

6 CERTIFICATION OF ACCURACY, NOTICE TO APPLICANT AND AUTHORITY TO RELEASE INFORMATION PLEASE READ INITIAL AND SIGN EACH PARAGRAPH BELOW. (Final signature must be witnessed by a Notary Public.) Oregon Revised Statute & states: A person commits a Class A Misdemeanor if the person knowingly falsifies information pertinent to an application for a license or certificate. I hereby authorize any person or organization to provide any information about me to the Department of Public Safety Standards and Training, including criminal history information, or any other information about me related to my character or fitness for licensing or certification under ORS or ORS I further authorize DPSST, or an authorized representative of the Board, to release to any law enforcement agency or employer or prospective employer any information held by DPSST concerning my application. I understand that the Board may also be required to release information from my file to other persons, pursuant to Oregon public records law. Initial I understand and agree that DPSST is required to deny, revoke or suspend certification/licensure if I have been convicted of a disqualifying crime. I understand that falsifying my application or a finding, by the Department, that information provided on the forms submitted in application, or that is contrary to my sworn oath are grounds for denial, revocation or suspension of my certification/licensure, and may subject me to civil penalty and/or prosecution. This includes if my criminal history check shows information contrary to that disclosed, or subsequent criminal, unethical or immoral activity. Initial I release the Department of Public Safety Standards and Training and its agents from any and all liability and responsibility, damages, and claims of any kind whatsoever arising from actions taken in fulfilling the departments statutory obligations. Initial I hereby declare under oath and under penalty of perjury that all information contained in this application is true and correct. I have read each of the paragraphs written above as indicated by my initials. I understand and agree to the terms and conditions as described. Printed Name of Applicant Signature of Applicant STATE OF OREGON, County of ) ss. On this day of, 200, personally appeared before me and signed the Certification of Accuracy in my presence, and I verified the applicant's identity by viewing photo identification. Signature of Notary Public

PRIVATE INVESTIGATOR APPLICANT INSTRUCTIONS

PRIVATE INVESTIGATOR APPLICANT INSTRUCTIONS COMMONWEALTH OF KENTUCKY KENTUCKY BOARD OF LICENSURE FOR PRIVATE INVESTIGATORS PO BOX 1360 FRANKFORT KY 40602-1360 (502) 564-3296, ext. 223 (502) 564-4818 FAX PRIVATE INVESTIGATOR APPLICANT INSTRUCTIONS

More information

PRIVATE INVESTIGATOR COMPANY APPLICANT INSTRUCTIONS

PRIVATE INVESTIGATOR COMPANY APPLICANT INSTRUCTIONS COMMONWEALTH OF KENTUCKY KENTUCKY BOARD LICENSURE FOR PRIVATE INVESTIGATORS PO BOX 1360 FRANKFORT KY 40602 (502) 564-3296, Ext. 239 (502) 56696-5230 FAX PRIVATE INVESTIGATOR COMPANY APPLICANT INSTRUCTIONS

More information

Ohio State Dental Board

Ohio State Dental Board Ohio State Dental Board 77 South High Street, 17th Floor Columbus, Ohio 43215-6135 www.dental.ohio.gov Phone #: 614/466-2580 Fax #: 614/752-8995 DENTAL HYGIENE REINSTATEMENT INFORMATION Dental Hygienists

More information

HEALTH LICENSING OFFICE Respiratory Therapist Polysomnographic Technologist Licensing Board

HEALTH LICENSING OFFICE Respiratory Therapist Polysomnographic Technologist Licensing Board HEALTH LICENSING OFFICE Respiratory Therapist Polysomnographic Technologist Licensing Board 700 Summer St. NE, Suite 320, Salem, OR, 97301 Phone: 503-378-8667 Fax: 503-370-9004 www.oregon.gov/oha/hlo Email:

More information

IDAHO CONCEALED WEAPONS PERMIT APPLICATION INFORMATION

IDAHO CONCEALED WEAPONS PERMIT APPLICATION INFORMATION IDAHO CONCEALED WEAPONS PERMIT APPLICATION INFORMATION Jerome County Sheriff's Office- Driver s License Office 300 North Lincoln Jerome, ID 83338 (208) 644-2770 Applicants please read all instructions

More information

Application for License to Carry a Concealed Handgun Umatilla County Sheriff s Office Terry L. Rowan

Application for License to Carry a Concealed Handgun Umatilla County Sheriff s Office Terry L. Rowan Page1 You must apply in person. Appointments are REQUIRED. Call 541-966-3680. First (Full Legal Name) Full Middle Last Date of Birth: Height: Weight: Eye Color: Hair Color: Driver s License #: State: Age:

More information

State of Oklahoma COUNCIL ON LAW ENFORCEMENT EDUCATION AND TRAINING INDIVIDUAL LICENSE SUPPLEMENT

State of Oklahoma COUNCIL ON LAW ENFORCEMENT EDUCATION AND TRAINING INDIVIDUAL LICENSE SUPPLEMENT State of Oklahoma COUNCIL ON LAW ENFORCEMENT EDUCATION AND TRAINING INDIVIDUAL LICENSE SUPPLEMENT LATE RENEWAL - SIX MONTHS TO TWO YEARS LATE 1. Complete this supplement. 2. Provide local record checks

More information

Montana Application for Class 6 Specialist License School Psychologist Endorsement

Montana Application for Class 6 Specialist License School Psychologist Endorsement Montana Application for Class 6 Specialist License School Psychologist Endorsement Requirements for Montana Class 6 School Psychologist Specialist license 1. Verification of current credentials as a nationally

More information

STATE OF KANSAS OFFICE OF THE ATTORNEY GENERAL Through the KANSAS BUREAU OF INVESTIGATION INSTRUCTIONS

STATE OF KANSAS OFFICE OF THE ATTORNEY GENERAL Through the KANSAS BUREAU OF INVESTIGATION INSTRUCTIONS STATE OF KANSAS OFFICE OF THE ATTORNEY GENERAL Through the KANSAS BUREAU OF INVESTIGATION INSTRUCTIONS RENEWAL OF PRIVATE DETECTIVE LICENSE *Complete this renewal form if you are an employee, owner, partner,

More information

CERTIFIED MEDICAL LANGUAGE INTERPRETER

CERTIFIED MEDICAL LANGUAGE INTERPRETER STATE OF UTAH DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING APPLICATION FOR CERTIFICATION CERTIFIED MEDICAL LANGUAGE INTERPRETER APPLICATION INSTRUCTIONS AND INFORMATION General Statement: The Utah

More information

Hempfield Township Board of Supervisors

Hempfield Township Board of Supervisors Hempfield Township Board of Supervisors 05/05/2015 MASSAGE THERAPIST APPLICATION Attach the following items at the time of application and renewal. Incomplete applications will not be processed or accepted.

More information

INSTRUCTIONS FOR COMPLETING DBPR ABT 6013 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR DISTRIBUTOR S SALESPERSON OF WINE OR SPIRITS

INSTRUCTIONS FOR COMPLETING DBPR ABT 6013 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR DISTRIBUTOR S SALESPERSON OF WINE OR SPIRITS INSTRUCTIONS FOR COMPLETING DBPR ABT 6013 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR DISTRIBUTOR S SALESPERSON OF WINE OR SPIRITS If you have any questions or need assistance in completing

More information

Judicial Council of Georgia

Judicial Council of Georgia Form 1 Judicial Council of Georgia CERTIFIED PROCESS SERVER APPLICATION 1. Name (Last Name) (First Name) (Middle Initial) 2. Address City State ZIP 3. Work Telephone ( ) 4. Alternate Telephone ( ) 5. of

More information

ARKANSAS STATE POLICE SECURITY OR INVESTIGATION COMPANY RENEWAL APPLICATION

ARKANSAS STATE POLICE SECURITY OR INVESTIGATION COMPANY RENEWAL APPLICATION ARKANSAS STATE POLICE SECURITY OR INVESTIGATION COMPANY RENEWAL APPLICATION FOR OFFICE USE ONLY EFFECTIVE 8-2015 EXPIRES PROCESSED BY NOTICE: Information contained on this application is considered a public

More information

ALASKA POLICE STANDARDS COUNCIL PERSONAL HISTORY STATEMENT

ALASKA POLICE STANDARDS COUNCIL PERSONAL HISTORY STATEMENT State of Alaska, Dept. of Corrections Div. of Administrative Services Human Resources PO Box 112000 Juneau, Alaska 99811 Ph: (907) 465-5492. (907)465-8409 ALASKA POLICE STANDARDS COUNCIL PERSONAL HISTORY

More information

INSTRUCTIONS FOR COMPLETING DBPR ABT 6006 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR CIGAR WHOLESALE DEALER PERMIT

INSTRUCTIONS FOR COMPLETING DBPR ABT 6006 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR CIGAR WHOLESALE DEALER PERMIT INSTRUCTIONS FOR COMPLETING DBPR ABT 6006 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR CIGAR WHOLESALE DEALER PERMIT If you have any questions or need assistance in completing this application,

More information

Criminal Justice Selection Center

Criminal Justice Selection Center Send all mail to: Gulf Coast Criminal Justice Selection Center http://www.gulfcoast.edu/north_bay/selection Our physical location: Criminal Justice Selection Center North Bay Campus, Abbott Building 5230

More information

Quincy Police Department One Sea Street Quincy, MA 02169 (617) 479-1212 TTY: (617) 376-1375

Quincy Police Department One Sea Street Quincy, MA 02169 (617) 479-1212 TTY: (617) 376-1375 PAUL KEENAN CHIEF OF POLICE Quincy Police Department One Sea Street Quincy, MA 02169 (617) 479-1212 TTY: (617) 376-1375 Please complete the attached Firearms Application. All questions must be answered

More information

Application for Initial Certification Emergency Medical Technician

Application for Initial Certification Emergency Medical Technician Application for Initial Certification Emergency Medical Technician Department Of Health & Social Services Division of Public Health Section of Emergency Programs P.O. Box 110616, Juneau, AK 99811-0616

More information

Michael Gayoso, Jr. Office of the County Attorney TH

Michael Gayoso, Jr. Office of the County Attorney TH Michael Gayoso, Jr. Office of the County Attorney TH 11 Judicial District/Crawford County, Kansas DIVERSION PROGRAM -- DRIVING UNDER THE INFLUENCE Pursuant to K.S.A. 22-2906 et seq. the Crawford County

More information

30 Day Limited Permits for Professional Engineers and Land Surveyors

30 Day Limited Permits for Professional Engineers and Land Surveyors THE STATE EDUCATION DEPARTMENT / THE UNIVERSITY OF THE STATE OF NEW YORK / ALBANY, NY 12234 Office of the Professions, State Board for Engineering and Land Surveying PHONE: 518-474-3817 ext. 140 FAX: 518-473-6282

More information

INSTRUCTIONS FOR COMPLETING DBPR ABT 6006 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR CIGAR WHOLESALE DEALER PERMIT

INSTRUCTIONS FOR COMPLETING DBPR ABT 6006 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR CIGAR WHOLESALE DEALER PERMIT INSTRUCTIONS FOR COMPLETING DBPR ABT 6006 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR CIGAR WHOLESALE DEALER PERMIT If you have any questions or need assistance in completing this application,

More information

OCCUPATIONAL THERAPY ASSISTANT or OCCUPATIONAL THERAPIST

OCCUPATIONAL THERAPY ASSISTANT or OCCUPATIONAL THERAPIST STATE OF UTAH DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING APPLICATION FOR LICENSURE OCCUPATIONAL THERAPY ASSISTANT or OCCUPATIONAL THERAPIST APPLICATION INSTRUCTIONS AND INFORMATION General Statement:

More information

Criminal Justice Institute

Criminal Justice Institute May 22, 2014 Dear Student: Thank you for your interest in obtaining your Florida certification as a law enforcement or correctional officer. The Equivalency-of-Training process enables one to become exempt

More information

APPLICATION FOR NATIONAL EXAMINATION IN MARITAL & FAMILY THERAPY

APPLICATION FOR NATIONAL EXAMINATION IN MARITAL & FAMILY THERAPY Minnesota Board of Marriage and Family Therapy 2829 University Avenue SE, Suite 400 Minneapolis, MN 55414-3222 Telephone: (612) 617-2220 Fax: (612) 617-2221 Email: mft.board@state.mn.us Website: www.bmft.state.mn.us

More information

INSTRUCTOR APPLICATION SOCIAL SECURITY #: DATE OF BIRTH: (MMDDYY): INSTRUCTOR #

INSTRUCTOR APPLICATION SOCIAL SECURITY #: DATE OF BIRTH: (MMDDYY): INSTRUCTOR # LOUISIANA STATE BOARD OF PRIVATE SECURITY EXAMINERS 15703 OLD HAMMOND HIGHWAY BATON ROUGE, LA 70816 (225) 272-2310 1-888-446-9436 FAX # (225) 272-5816 http://lsbpse.info INSTRUCTOR APPLICATION APPLICANT

More information

Kentucky Motor Vehicle Commission SALESPERSON LICENSE APPLICATION IMPORTANT NOTICE REGARDING ALL SALES PERSONNEL

Kentucky Motor Vehicle Commission SALESPERSON LICENSE APPLICATION IMPORTANT NOTICE REGARDING ALL SALES PERSONNEL IMPORTANT NOTICE REGARDING ALL SALES PERSONNEL All persons employed by a dealership in a sales capacity, even if on a temporary basis, and those individuals identified in 605 KAR 1:050 Section 5 must be

More information

Massachusetts Board of Registration in Pharmacy. Pharmacy Technician Registration Application

Massachusetts Board of Registration in Pharmacy. Pharmacy Technician Registration Application The Massachusetts Board of (Board) has contracted with Professional Credential Services (PCS) to process registration applications from pharmacy technicians. Applicants must submit all information directly

More information

Private Protective Services - Contract Security Company Application, Page 1

Private Protective Services - Contract Security Company Application, Page 1 Private Protective Services - Contract Security Company Application, Page 1 STATE OF TENNESSEE DEPARTMENT OF COMMERCE & INSURANCE DIVISION OF REGULATORY BOARDS PRIVATE PROTECTIVE SERVICES 500 JAMES ROBERTSON

More information

APPLICATION FOR A PEDDLER, SOLICITOR OR TRANSIENT MERCHANT LICENSE. Fee $60 per Solicitor

APPLICATION FOR A PEDDLER, SOLICITOR OR TRANSIENT MERCHANT LICENSE. Fee $60 per Solicitor CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 763-572-3523 www.fridleymn.gov Check # License # Expiration April 30, APPLICATION FOR A PEDDLER, SOLICITOR OR TRANSIENT MERCHANT LICENSE Business

More information

ACCOUNTING PRACTITIONER LICENSING REQUIREMENTS

ACCOUNTING PRACTITIONER LICENSING REQUIREMENTS ACCOUNTING PRACTITIONER LICENSING REQUIREMENTS 1. No prior history of dishonest or felonious acts: 2. Be a resident of this State or have a place of business in this State, or as an employee, be regularly

More information

Texas Department of Insurance Individual Insurance License Application

Texas Department of Insurance Individual Insurance License Application Texas Department of Insurance Individual Insurance License Application This application is only for applicants who must take or have taken a Prometric examination and applicants for a temporary license.

More information

To be considered for the position of Communications Officer you will be asked to participate in the following:

To be considered for the position of Communications Officer you will be asked to participate in the following: Dear Communications Officer Applicant: Thank you for your interest in the position of Communications Officer with Athens- Clarke County Police Department. Enclosed you will find the information and application

More information

MONTANA BOARD OF PUBLIC ACCOUNTANTS

MONTANA BOARD OF PUBLIC ACCOUNTANTS MONTANA BOARD OF PUBLIC ACCOUNTANTS 301 South Park 4 th Floor PO Box 200513 Helena Mt 59620 0513 Phone: 406 841 2203 E mail: dlibsdpac@mt.gov Website: www.publicaccountant.mt.gov APPLICATION FOR ORIGINAL

More information

COMMUNITY ASSOCIATION MANAGER APPLICATION FOR LICENSURE

COMMUNITY ASSOCIATION MANAGER APPLICATION FOR LICENSURE COMMUNITY ASSOCIATION MANAGER APPLICATION FOR LICENSURE ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION Division of Professional Regulation 320 West Washington Street, 3 rd Floor Springfield,

More information

RHODE ISLAND DEPARTMENT OF LABOR AND TRAINING DIVISION OF WORKFORCE REGULATION AND SAFETY PROFESSIONAL REGULTION UNIT

RHODE ISLAND DEPARTMENT OF LABOR AND TRAINING DIVISION OF WORKFORCE REGULATION AND SAFETY PROFESSIONAL REGULTION UNIT RHODE ISLAND DEPARTMENT OF LABOR AND TRAINING DIVISION OF WORKFORCE REGULATION AND SAFETY PROFESSIONAL REGULTION UNIT NEW ALARM BUSNIESS LICENSE REQUIERMENTS: Application for Alarm Business License must

More information

APPLICATION FOR PHARMACIST EXAMINATION

APPLICATION FOR PHARMACIST EXAMINATION Applicant s Name: 9901/001 Application $ 50.00 9901/001 Licensure fee $ 165.00 9901/006 Regulatory fee $ 10.00 9901/001 Application $300.00 9901/001 Score Transfer $165.00 9901/006 Regulatory fee $10.00

More information

INSTRUCTIONS FOR EMS EXAMINATION AND LICENSURE/CERTIFICATION APPLICATION

INSTRUCTIONS FOR EMS EXAMINATION AND LICENSURE/CERTIFICATION APPLICATION INSTRUCTIONS FOR EMS EXAMINATION AND LICENSURE/CERTIFICATION APPLICATION ALL COURSEWORK AND FINAL EXAMS MUST BE COMPLETED PRIOR TO APPLICATION. Provide all applicable information requested. Missing information

More information

Nexteer Automotive Page 1

Nexteer Automotive Page 1 PLEASE FILL OUT ALL PORTIONS COMPLETELY AND ACCURATELY. IN ACCORDANCE WITH STATE AND FEDERAL LAWS, NEXTEER AUTOMOTIVE (THE EMPLOYER) DOES NOT DISCRIMINATE ON THE BASIS OF AGE, RACE, RELIGION, COLOR, SEX,

More information

GLYNN COUNTY SHERIFF S OFFICE IS AN EQUAL OPPORTUNITY EMPLOYER

GLYNN COUNTY SHERIFF S OFFICE IS AN EQUAL OPPORTUNITY EMPLOYER P.O. Box 793 100 Sulphur Springs Road Brunswick, GA 31520 Telephone: (912) 554-7600 * Fax: (912) 554-7681 Web Page Address: www.glynncountysheriff.org INSTRUCTIONS AND INFORMATION PLEASE READ CAREFULLY

More information

For any questions contact: City Clerk Michelle Tesser Tel: 651-450-2513 Fax: 651-259-8023 mtesser@invergroveheights.org

For any questions contact: City Clerk Michelle Tesser Tel: 651-450-2513 Fax: 651-259-8023 mtesser@invergroveheights.org INSTRUCTIONS FOR THE APPLICATION OF MASSAGE THERAPIST LICENSE THERAPEUTIC MASSAGE BUSINESS LICENSE City of Inver Grove Heights 8150 Barbara Ave, Inver Grove Heights, MN 55077 (651) 450-2500 Fax (651) 450-2502

More information

MASSAGE THERAPY CERTIFICATE 2016 LICENSE APPLICATION INSTRUCTIONS City of Plymouth 3400 Plymouth Boulevard, Plymouth, MN 55447 763-509-5000

MASSAGE THERAPY CERTIFICATE 2016 LICENSE APPLICATION INSTRUCTIONS City of Plymouth 3400 Plymouth Boulevard, Plymouth, MN 55447 763-509-5000 MASSAGE THERAPY CERTIFICATE 2016 LICENSE APPLICATION INSTRUCTIONS City of Plymouth 3400 Plymouth Boulevard, Plymouth, MN 55447 763-509-5000 The following application forms must be completed, by the individual

More information

To ensure your application is complete we will check your application with this list to make sure you ve done the following:

To ensure your application is complete we will check your application with this list to make sure you ve done the following: To ensure your application is complete we will check your application with this list to make sure you ve done the following: Read the first page if you understand and agree sign and date it at the bottom.

More information

Grandparent s Power of Attorney Information and Forms

Grandparent s Power of Attorney Information and Forms NOTICE AND DISCLAIMER Grandparent s Power of Attorney Information and Forms The forms in this packet have been provided to you as a public service by the Butler County Juvenile Court. Although you may

More information

FINGERPRINT BACKGROUND CHECK

FINGERPRINT BACKGROUND CHECK APPLICATION FOR LICENSURE PHARMACY TECHNICIAN (Non-Renewable: Expires the second June 30 from the date of issuance) OR CERTIFIED OREGON PHARMACY TECHNICIAN (Expires June 30, 2018) OREGON BOARD OF PHARMACY

More information

NOTICE TO JOB APPLICANTS

NOTICE TO JOB APPLICANTS NOTICE TO JOB APPLICANTS JOB POSTINGS CAN BE FOUND ON THE CITY OF ATHENS WEB SITE AT WWW.ATHENSAL.US APPLICATIONS ARE ACCEPTED ONLY FOR POSTED VACANCIES THAT ARE LISTED AS EXTERNAL VACANCY. APPLICATIONS

More information

Maynard Police Department

Maynard Police Department Maynard Police Department Chief Mark W. Dubois INSTRUCTIONS FOR LICENSE TO CARRY FIREARMS AND F. I. D. CARD APPLICANTS The following officers will be available (depending on their shifts and work days)

More information

State of Florida Department of Business and Professional Regulation Mold Related Services Application for Licensure Form # DBPR MRS 0701

State of Florida Department of Business and Professional Regulation Mold Related Services Application for Licensure Form # DBPR MRS 0701 State of Florida Department of Business and Professional Regulation Mold Related Services Application for Licensure Form # DBPR MRS 0701 1 of 11 APPLICATION CHECKLIST IMPORTANT Submit all items on the

More information

PLEASE READ BEFORE COMPLETING APPLICATION

PLEASE READ BEFORE COMPLETING APPLICATION PLEASE READ BEFORE COMPLETING APPLICATION Information for Licensure: SOCIAL WORKER (LSW) Each item on the enclosed application must be completed. Allow 30 days for processing of the application. Failure

More information

APPLICATION FOR DOMESTIC RECIPROCITY LICENSE. The State Board of Cosmetology may grant license by reciprocity, without examination, if:

APPLICATION FOR DOMESTIC RECIPROCITY LICENSE. The State Board of Cosmetology may grant license by reciprocity, without examination, if: 2401 NW 23rd Street, Suite 84 Reciprocity Department 405.522.7620 Fax 405.521.2440 MARY FALLIN GOVERNOR SHERRY G. LEWELLING EXECUTIVE DIRECTOR APPLICATION FOR DOMESTIC RECIPROCITY LICENSE The State Board

More information

Department of Education Alternative Route to Certification Program Application

Department of Education Alternative Route to Certification Program Application Certification Office 800 Governors Drive Pierre, South Dakota 57501 certification@state.sd.us Telephone: 605.773.3426 Department of Education Alternative Route to Certification Program Application Instructions

More information

SHORT FORM For Use by presently certified firms.

SHORT FORM For Use by presently certified firms. Economic Development Department Minority and Women-Owned Business Enterprise Certification Application SHORT FORM For Use by presently certified firms. M/WBE Certification Application, Short Form Rev.

More information

State of Maine Office of the Secretary of State

State of Maine Office of the Secretary of State State of Maine Office of the Secretary of State Application for a Notary Public Commission This section is for office use only. Notary Public #: Commission issued: for a Maine Resident Please read these

More information

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing.

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing. State of Florida Department of Business and Professional Regulation Board of Cosmetology Application for Hair Braiding, Hair Wrapping and Body Wrapping Registration Form # DBPR COSMO 5 1 of 7 APPLICATION

More information

Regulation and Licensing Branch 12000 Government Center Parkway, Suite 127 Fairfax, Virginia 22035-0047

Regulation and Licensing Branch 12000 Government Center Parkway, Suite 127 Fairfax, Virginia 22035-0047 License Number: County of Fairfax, Virginia Department of Cable and Consumer Services Regulation and Licensing Branch 12000 Government Center Parkway, Suite 127 Fairfax, Virginia 22035-0047 Telephone 703-324-5966

More information

Licensure by Examination Information For Graduates from Nursing programs within the United States

Licensure by Examination Information For Graduates from Nursing programs within the United States 17938 SW Upper Boones Ferry Road Portland, Oregon 97224-7012 Licensure by Examination Information For Graduates from Nursing programs within the United States Non-United States Graduate: If you studied

More information

Office of the Sheriff

Office of the Sheriff Office of the Sheriff Pistol Permit Applications Guidelines Permit must be completed neatly and filled out prior to turning it in for processing. Any application that is not completed neatly will be rejected

More information

APPLICATION FOR CERTIFIED NURSE AIDE BY EXAMINATION

APPLICATION FOR CERTIFIED NURSE AIDE BY EXAMINATION THE STATE of ALASKA Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing Nurse Aide Registry 550 West 7 th Avenue, Suite 1500 Anchorage,

More information

STATE OF NEVADA DEPARTMENT OF BUSINESS AND INDUSTRY REAL ESTATE DIVISION 2501 East Sahara Avenue, Suite 102 * Las Vegas, NV 89104-4137 *(702) 486-4033

STATE OF NEVADA DEPARTMENT OF BUSINESS AND INDUSTRY REAL ESTATE DIVISION 2501 East Sahara Avenue, Suite 102 * Las Vegas, NV 89104-4137 *(702) 486-4033 NEVADA OUT-OF-STATE COOPERATIVE CERTIFICATE CHECKLIST AND APPLICATION Cooperative Certificates are for A SINGLE TRANSACTION ONLY and NOT MEANT for conducting general real estate business on a day-to-day

More information

May be furnished by any three (3) persons who have known the applicant (agent) for at least three (3) years. Include name, address & phone number.

May be furnished by any three (3) persons who have known the applicant (agent) for at least three (3) years. Include name, address & phone number. Two Original Applications Personal History Form Lease or Valid Document Photographs Corporate Papers Letters of Reference Financial Investments Please write legibly in BLACK ink or type information. Answer

More information

KANAWHA COUNTY SHERIFF'S OFFICE License Application Instructions WV Code License to Carry Deadly Weapon

KANAWHA COUNTY SHERIFF'S OFFICE License Application Instructions WV Code License to Carry Deadly Weapon KANAWHA COUNTY SHERIFF'S OFFICE License Application Instructions WV Code 61-7-4 License to Carry Deadly Weapon The Concealed Pistol/Revolver License Application may be downloaded from the website of the

More information

State of Oklahoma COUNCIL ON LAW ENFORCEMENT EDUCATION AND TRAINING Private Security Licensing Division

State of Oklahoma COUNCIL ON LAW ENFORCEMENT EDUCATION AND TRAINING Private Security Licensing Division State of Oklahoma COUNCIL ON LAW ENFORCEMENT EDUCATION AND TRAINING Private Security Licensing Division CLEET Private Security Division Ada, Oklahoma 74820-0669 (405) 239-5100 Dear Agency Applicant: Thank

More information

Disregard all information in the paper application packet regarding fingerprinting!

Disregard all information in the paper application packet regarding fingerprinting! Disregard all information in the paper application packet regarding fingerprinting! If you anticipate having your fingerprints received by the Board office after January 1, 2013 do not use a paper fingerprint

More information

OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney

OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney Shawnee County Courthouse Fax: (785) 251-4909 200 SE 7th Street, Suite 214 Family Law Fax: (785)

More information

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing.

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing. 1 of 8 State of Florida Department of Business and Professional Regulation Board of Cosmetology Application for Initial License by Exam Based on Current Licensure in Another State or Country Form # DBPR

More information

TOM GREEN COUNTY BAIL BOND INDIVIDUAL SURETY LICENSE APPLICATION

TOM GREEN COUNTY BAIL BOND INDIVIDUAL SURETY LICENSE APPLICATION New Application Renewal Application TOM GREEN COUNTY BAIL BOND INDIVIDUAL SURETY LICENSE APPLICATION **Submit Original & 14 Copies with filing fee to Tom Green County Treasurer** NO APPLICATION SHALL BE

More information

APPLICATION FOR LICENSE BY EXAMINATION NURSING HOME ADMINISTRATOR

APPLICATION FOR LICENSE BY EXAMINATION NURSING HOME ADMINISTRATOR APPLICATION FOR LICENSE BY EXAMINATION NURSING HOME ADMINISTRATOR WEST VIRGINIA NURSING HOME ADMINISTRATORS LICENSING BOARD P. O. BOX 522 WINFIELD, WV 25213 Surname Given Name Middle/Maiden Name INSTRUCTIONS

More information

Application for New Louisiana Pharmacy Technician Candidate Registration

Application for New Louisiana Pharmacy Technician Candidate Registration Louisiana Board of Pharmacy 3388 Brentwood Drive Baton Rouge, Louisiana 70809-1700 Telephone 225.925.6496 ~ Facsimile 225.925.6499 www.pharmacy.la.gov ~ E-mail: info@pharmacy.la.gov Application for New

More information

APPLICATION FOR PHARMACY TECHNICIAN REGISTRATION Information for Individuals who desire to register as a Pharmacy Technician

APPLICATION FOR PHARMACY TECHNICIAN REGISTRATION Information for Individuals who desire to register as a Pharmacy Technician NAME 9906/001 Application $75.00 9906/006 Regulatory $10.00 STATE OF TENNESSEE DEPARTMENT OF HEALTH DIVISION OF HEALTH LICENSURE AND REGULATION www.tennessee.gov/health APPLICATION FOR PHARMACY TECHNICIAN

More information

Cash Line Number (For Department Use Only)

Cash Line Number (For Department Use Only) NEW YORK STATE EPARTMENT OF HEALTH NURSING HOME ADMINISTRATOR LICENSURE APPLICATION Cash Line Number (For Department Use Only) QUALIFICATIONS To Qualify for licensure as a nursing home administrator in

More information

ARKANSAS STATE POLICE SECURITY OR INVESTIGATION COMPANY APPLICATION

ARKANSAS STATE POLICE SECURITY OR INVESTIGATION COMPANY APPLICATION ARKANSAS STATE POLICE SECURITY OR INVESTIGATION COMPANY APPLICATION FOR OFFICE USE ONLY EFFECTIVE 8-2015 EXPIRES PROCESSED BY NOTICE: Information contained on this application is considered a public record

More information

OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney

OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney Shawnee County Courthouse Fax: (785) 251-4909 200 SE 7th Street, Suite 214 Family Law Fax: (785)

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT FRONTRUNNERS NEW BALANCE STORES LOS ANGELES 2828 Wilshire Blvd Santa Monica CA 90403 APPLICATION FOR EMPLOYMENT BACKGROUND CHECKS Frontrunners/NBLA is concerned about violence in the workplace, falsified

More information

STATE OF MAINE OCCUPATIONAL THERAPY PRACTICE APPLICATION FOR LICENSURE

STATE OF MAINE OCCUPATIONAL THERAPY PRACTICE APPLICATION FOR LICENSURE STATE OF MAINE OCCUPATIONAL THERAPY PRACTICE APPLICATION FOR LICENSURE Temporary Occupational Therapist Temporary Occupational Therapy Assistant Department of Professional and Financial Regulation Office

More information

STATE OF TENNESSEE EMPLOYMENT APPLICATION

STATE OF TENNESSEE EMPLOYMENT APPLICATION USE BLACK INK ONLY TO COMPLETE THIS APPLICATION FORM. REQUIRED FIELDS OR YOUR APPLICATION WILL BE RETURNED TO YOU. PLEASE COMPLETE ALL Please record your Social Security Number below. List the specific

More information

The University of the State of New York. THE STATE EDUCATION DEPARTMENT Office of the Professions

The University of the State of New York. THE STATE EDUCATION DEPARTMENT Office of the Professions The University of the State of New York Certified Public Accountant THE STATE EDUCATION DEPARTMENT Office of the Professions Form 1 Division of Professional Licensing Services www.op.nysed.gov Application

More information

Illinois Retired Officer Concealed Carry

Illinois Retired Officer Concealed Carry IROCC Illinois Retired Officer Concealed Carry 840 S. Spring, Suite B Phone: 217/726-9537 Springfield, Illinois 62704 Fax: 217/726-9539 www.ilconcealedcarry.org Email: irocc@letac.org Dear Applicant: Under

More information

APPLICATION TO PRACTICE TELEMEDICINE

APPLICATION TO PRACTICE TELEMEDICINE MINNESOTA BOARD OF MEDICAL PRACTICE University Park Plaza 2829 University Avenue SE Suite 500 Minneapolis, MN 55414-3246 Telephone 612-617-2130 Fax 612-617-2166 www.bmp.state.mn.us MN Relay Service for

More information

GEORGIA BOARD OF PHARMACY 2 Peachtree Street, N.W. 36 th Floor Atlanta, Georgia 30303

GEORGIA BOARD OF PHARMACY 2 Peachtree Street, N.W. 36 th Floor Atlanta, Georgia 30303 GEORGIA BOARD OF PHARMACY 2 Peachtree Street, N.W. 36 th Floor Atlanta, Georgia 30303 PHARMACY TECHNICIAN INFORMATION SHEET AND CHECKLIST In accordance with O.C.G.A. 26-4-28, the Georgia Board of Pharmacy

More information

South Dakota Board of Nursing Facility Administrators P.O. Box 340, 1351 N. Harrison Ave. Pierre, SD 57501-0340 Ph.: 605-224-1721 Fax: 888-425-3032

South Dakota Board of Nursing Facility Administrators P.O. Box 340, 1351 N. Harrison Ave. Pierre, SD 57501-0340 Ph.: 605-224-1721 Fax: 888-425-3032 South Dakota Board of Nursing Facility Administrators P.O. Box 340, 1351 N. Harrison Ave. Pierre, SD 57501-0340 Ph.: 605-224-1721 Fax: 888-425-3032 E-mail: SDNFA@midwestsolutionssd.com http://nursingfacility.sd.gov

More information

STATE COURT OF FULTON COUNTY Appointment of Permanent Process Server Packet

STATE COURT OF FULTON COUNTY Appointment of Permanent Process Server Packet STATE COURT OF FULTON COUNTY 2017 Appointment of Permanent Process Server Packet State Court Permanent Process Servers 1 st Time Applicant Renewal Any and all permanent process server orders from the State

More information

LICENSING AT A LOWER LEVEL

LICENSING AT A LOWER LEVEL EMS-APP-500 (11/2014) Michigan Department of Community Health Lansing, Michigan 48909 Website: www.michigan.gov/ems Authority: P.A. 368 of 1978, as amended This form is for information only. MICHIGAN COURSE

More information

Fairview Recovery Services, Inc. Application for Employment

Fairview Recovery Services, Inc. Application for Employment Fairview Recovery Services, Inc. Application for Employment Equal Opportunity/Culturally Competent/Affirmative Action Employer Fairview Recovery Services, Inc. strongly encourages women and minorities

More information

NOTE: All mailings will be sent to the address you indicate below; if you change your address, you must advise this office.

NOTE: All mailings will be sent to the address you indicate below; if you change your address, you must advise this office. ATTACHMENT G 7/2013 STATE OF NEBRASKA Department of Health and Human Services Division of Public Health - Licensure Unit P.O. Box 94986 - Lincoln, Nebraska 68509-4986 Telephone #: 402-471-4918 Rita.watson@nebraska.gov

More information

CITY OF BURNSVILLE, MINNESOTA POLICE DEPARTMENT

CITY OF BURNSVILLE, MINNESOTA POLICE DEPARTMENT CITY OF BURNSVILLE, MINNESOTA POLICE DEPARTMENT 100 Civic Center Parkway Burnsville, Minnesota 55337 952-895-4600 Fax 952-895-4640 Eric J Gieseke Chief of Police IMPORTANT REMINDERS FOR COMPLETEING PERMIT

More information

South Texas Lighthouse for the Blind. California Employment Application

South Texas Lighthouse for the Blind. California Employment Application South Texas Lighthouse for the Blind Main Office: P. O. Box 9697 Ph. 888-255-8011 Corpus Christi, TX 78469 Fax 361-883-1041 South Texas Lighthouse for the Blind is an Equal Opportunity and Affirmative

More information

LAS VEGAS METROPOLITAN POLICE DEPARTMENT APPLICATION FOR CONCEALED FIREARM PERMIT GENERAL INFORMATION AND INSTRUCTIONS

LAS VEGAS METROPOLITAN POLICE DEPARTMENT APPLICATION FOR CONCEALED FIREARM PERMIT GENERAL INFORMATION AND INSTRUCTIONS LAS VEGAS METROPOLITAN POLICE DEPARTMENT APPLICATION FOR CONCEALED FIREARM PERMIT GENERAL INFORMATION AND INSTRUCTIONS I) INITIAL APPLICATION ($97.50) A) Training 1) Applicant must complete a Basic Firearms

More information

Application Letter of Instruction

Application Letter of Instruction STATE OF NEVADA BOARD OF OCCUPATIONAL THERAPY P.O. BOX 34779 Reno, Nevada 89533-4779 (775) 746-4101 / Fax: (775) 746-4105 / Toll Free: (800) 431-2659 Email: board@nvot.org / Website: www.nvot.org TYPES

More information

ALL PERMITS ARE ISSUED ONLY AFTER A SATISFACTORY BACKGROUND INVESTIGATION. YOU WILL BE NOTIFIED BY MAIL OF THE PERMIT ISSUANCE OR DENIAL.

ALL PERMITS ARE ISSUED ONLY AFTER A SATISFACTORY BACKGROUND INVESTIGATION. YOU WILL BE NOTIFIED BY MAIL OF THE PERMIT ISSUANCE OR DENIAL. THE COUNTY OF CHESTERFIELD VIRGINIA CHESTERFIELD COUNTY POLICE DEPARTMENT 10001 IRON BRIDGE ROAD, CHESTERFIELD, VA 23832 APPLICATION FOR PRECIOUS METAL DEALERS PERMIT NON TRANSFERABLE Application Fee:

More information

APPLICATION FOR PRIVATE ACADEMIC SCHOOL TEACHING CERTIFICATE FORM PDE 4536 (Refer to instructions included with this two page form)

APPLICATION FOR PRIVATE ACADEMIC SCHOOL TEACHING CERTIFICATE FORM PDE 4536 (Refer to instructions included with this two page form) APPLICATION FOR PRIVATE ACADEMIC SCHOOL TEACHING CERTIFICATE FORM PDE 4536 (Refer to instructions included with this two page form) PDE USE ONLY CONTROL NO. APPLICANTS: Please note the following information

More information

Part 2 Peace Officer Training and Certification Act

Part 2 Peace Officer Training and Certification Act Part 2 Peace Officer Training and Certification Act 53-6-201 Short title. This part is known as the "Peace Officer Training and Certification Act." Enacted by Chapter 234, 1993 General Session 53-6-202

More information

RADIOLOGIC TECHNOLOGIST or RADIOLOGY PRACTICAL TECHNICIAN

RADIOLOGIC TECHNOLOGIST or RADIOLOGY PRACTICAL TECHNICIAN STATE OF UTAH DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING APPLICATION FOR LICENSURE RADIOLOGIC TECHNOLOGIST or RADIOLOGY PRACTICAL TECHNICIAN APPLICATION INSTRUCTIONS AND INFORMATION General Statement:

More information

APPLICATION FOR A YACHT AND SHIP EMPLOYING BROKER, BROKER OR SALESPERSON'S LICENSE

APPLICATION FOR A YACHT AND SHIP EMPLOYING BROKER, BROKER OR SALESPERSON'S LICENSE APPLICATION FOR A YACHT AND SHIP EMPLOYING BROKER, BROKER OR SALESPERSON'S LICENSE Attached please find the application for a yacht and ship employing broker, broker or salesperson's license. Once received,

More information

Massage Therapist License Application 12350 W 87 Street Pkwy Phone 913-477-7500 P.O. Box 14888 Fax 913-477-7730 Lenexa, KS 66285-4888 www.lenexa.

Massage Therapist License Application 12350 W 87 Street Pkwy Phone 913-477-7500 P.O. Box 14888 Fax 913-477-7730 Lenexa, KS 66285-4888 www.lenexa. Massage Therapist License Application 12350 W 87 Street Pkwy Phone 913-477-7500 P.O. Box 14888 Fax 913-477-7730 Lenexa, KS 66285-4888 www.lenexa.com NOTE: Any failure to fully or truthfully answer any

More information

2. Personal History Form Complete one Personal History form.

2. Personal History Form Complete one Personal History form. 1. Two Original Applications Please write legibly in BLACK ink or type information. Answer all questions appropriately and in detail. Applications must be signed, dated, and notarized. 2. Personal History

More information

ADJUSTER TESTING AND LICENSING INSTRUCTIONS FOR FORM AID-LI-ADJ RESIDENT ADJUSTER

ADJUSTER TESTING AND LICENSING INSTRUCTIONS FOR FORM AID-LI-ADJ RESIDENT ADJUSTER Rev. 8/1/2014 ARKANSAS INSURANCE DEPARTMENT LICENSE DIVISION 1200 WEST 3 RD STREET LITTLE ROCK AR 72201 PHONE NUMBER 501-371-2750 FAX NUMBER 501-683-2607 WEBSITE: http://www.insurance.arkansas.gov/license.htm

More information

REVISED 07-15 STATE BOARD OF SOCIAL WORKERS, MARRIAGE AND FAMILY THERAPISTS AND PROFESSIONAL COUNSELORS P.O. BOX 2649 HARRISBURG, PA 17105-2649

REVISED 07-15 STATE BOARD OF SOCIAL WORKERS, MARRIAGE AND FAMILY THERAPISTS AND PROFESSIONAL COUNSELORS P.O. BOX 2649 HARRISBURG, PA 17105-2649 STATE BOARD OF SOCIAL WORKERS, MARRIAGE AND FAMILY THERAPISTS AND PROFESSIONAL COUNSELORS P.O. BOX 2649 HARRISBURG, PA 17105-2649 Email st-socialwork@pa.gov www.dos.pa.gov/social APPLICATION FOR A LICENSE

More information

Pharmacy Technician. Program. Weatherford College in Partnership with Condensed Curriculum International (CCI) KEEP THIS SCHEDULE FOR YOUR RECORDS.

Pharmacy Technician. Program. Weatherford College in Partnership with Condensed Curriculum International (CCI) KEEP THIS SCHEDULE FOR YOUR RECORDS. Pharmacy Technician Weatherford College in Partnership with Condensed Curriculum International (CCI) Program Summary: As a Pharmacy Technician you will help the pharmacist package or mix prescriptions,

More information

EASTERN FLORIDA STATE COLLEGE PUBLIC SAFETY INSTITUTE

EASTERN FLORIDA STATE COLLEGE PUBLIC SAFETY INSTITUTE EASTERN FLORIDA STATE COLLEGE PUBLIC SAFETY INSTITUTE Application for the 911 Public Safety TelecommunicatorAcademy RETURN THIS ENTIRE APPLICATION AND ALL REQUESTED SUPPORTING DOCUMENTATION IN PERSON OR

More information

DEPARTMENT OF HEALTH. APPLICATION FOR LIMITED LICENSURE and Instructions

DEPARTMENT OF HEALTH. APPLICATION FOR LIMITED LICENSURE and Instructions DEPARTMENT OF HEALTH BOARD OF CLINICAL SOCIAL WORK, MARRIAGE AND FAMILY THERAPY AND MENTAL HEALTH COUNSELING APPLICATION FOR LIMITED LICENSURE and Instructions APPLICATION FOR LIMITED LICENSURE INSTRUCTIONS

More information